Owei Lily, Swendiman Robert A, Kelz Rachel R, Dempsey Daniel T, Dumon Kristoffel R
Department of Surgery, Hospital of the University of Pennsylvania, Pennsylvania, PA.
Department of Surgery, Hospital of the University of Pennsylvania, Pennsylvania, PA.
Surgery. 2017 Dec;162(6):1320-1329. doi: 10.1016/j.surg.2017.07.025. Epub 2017 Sep 28.
A large proportion of patients presenting for ventral hernia repair are obese. It remains unclear, however, whether the degree of obesity is an independent risk factor for adverse outcomes after ventral hernia repair. This study aims to characterize the influence of body mass index class on postoperative complications after open ventral hernia repair.
A retrospective analysis was conducted using data from the database of the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2015. Patients were stratified into 7 body mass index classes, as well as by type of hernia (reducible versus strangulated) and time of repair (initial versus recurrent). We determined the relationships between body mass index class and patient demographics, comorbidities, and risk of perioperative complications.
Our cohort consisted of 102,191 patients, 58.5% of whom were obese. When stratified by body mass index class, higher classes were associated with all postoperative complications (P < .0001) with a steady increase in complication rates with increasing body mass index class. Patients with strangulated hernias had greater complication rates than those with reducible hernias (P < .0001). Patients with recurrent hernias also had greater complication rates than those with initial hernias (P < .0001).
Increased body mass index is a risk factor for operative, medical, and respiratory complications after open ventral hernia repair. Patients with body mass index >40 kg/m have greater than twice the risk for complications with odds ratios increasing with increasing body mass index class. Strategies to encourage weight loss may need to be considered seriously prior to open ventral hernia repair, especially for patients with body mass index >40 kg/m.
接受腹疝修补术的患者中很大一部分是肥胖者。然而，肥胖程度是否是腹疝修补术后不良结局的独立危险因素仍不清楚。本研究旨在描述体重指数类别对开放性腹疝修补术后并发症的影响。
利用美国外科医师学会国家外科质量改进计划数据库2005年至2015年的数据进行回顾性分析。患者被分为7个体重指数类别，同时根据疝的类型（可复性与绞窄性）和修补时间（初次与复发性）进行分层。我们确定了体重指数类别与患者人口统计学、合并症及围手术期并发症风险之间的关系。
我们的队列包括102191例患者，其中58.5%为肥胖者。按体重指数类别分层时，较高类别与所有术后并发症相关（P < .0001），并发症发生率随体重指数类别增加而稳步上升。绞窄性疝患者的并发症发生率高于可复性疝患者（P < .0001）。复发性疝患者的并发症发生率也高于初次疝患者（P < .0001）。
体重指数增加是开放性腹疝修补术后手术、医疗和呼吸并发症的危险因素。体重指数>40 kg/m²的患者并发症风险增加两倍以上，优势比随体重指数类别增加而升高。在进行开放性腹疝修补术前，可能需要认真考虑鼓励减肥的策略，尤其是对于体重指数>40 kg/m²的患者。
